Objectives: The present study was designed as a trial to improve field
visibility during functional endoscopic sinus surgery (FESS) by means of
positional changes and the use of controlled hypotension achieved
through maintenance of anesthesia using remifentanH and either ofpropofol
infusion (Total Intravenous: TI) or isqflurane inhalation (Combined
Intravenous/Ihhalational; C1I).
Patients & Methods: The study included 32 patients; 23 males and
9 females, with mean age of 39.28.4 years and assigned to undergo
FESS. Patients were divided randomly into two equal groups according
maintenance anesthetic regimen Group TI and Group CH. Each group
was subdivided according to patients' position during surgery into supine
and anti-Trendelenburg by 30. Anesthesia was maintained in both
groups by infusion of 0.5 pg/kg/min of remifentanil in addition to 10 pg/
kg/min propofol infusion in Group TI or isoflurane 2% in Group CII. Pa
tients were monitored non-invasively; before induction of anesthesia (TO)
and 20 (T20), 40 (T40) and 60 min (T60) after induction of anesthesia, for
mean arterial pressure (MAP) and heart rate (HR). The approachfor FESS
was conducted totally endonasal The visibility of the operative field dur
ing FESS was evaluated using &points Fromme scale and total amount
of bleeding as fudged by the amount evacuated was also recorded.
Results: Both anesthetic modalities reduced blood pressure signifi
cantly and decreased heart rate throughout times of observation com
pared to preoperative levels with significantly lower MAP measures in
anti-Trendelenburg compared to supine position. All surgeries were con
ducted completely without intraoperative complications and no extensive
bleeding was recorded. There was a significant increase in the frequency ofgoodjield visibility with TI compared to CII anesthesia with significant
ly improved field, visibility in patients maintained in anti-Trendelenburg
position compared to supine position. Estimated mean blood loss was sig
nificantly less and the recorded field visibility scores were significantly
higher in TI group compared to CH group. There was a negative signifi
cant correlation between the field visibility score and mean MAP and
mean amount of bleeding. Using regression analysis, the use of hypotensive
anesthesia was found to be a significant independent factor for im
proving filed visibility, and the use ofTl anesthesia was found to be sig
nificant determinant independent factor for induction of hypotensive
anesthesia. The receiver operating characteristic (ROC) carve analysis
judged by the area under the curve (AUC) defined the superiority of use of
TI over CII anesthesia as independent determinant for field visibility.
Conclusion: It could be concluded that maintaining patients in anti- Trendelenburg position and anesthetic manipulation using total intrave
nous anesthesia could minimize bleeding and improve field visibility dur
ing FESS and thus this combination of manipulations could be appropri
ate strategy for such type of surgery. |
